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Unnecessary inductions raise risk of complications

Pregnant women who are induced for “non-recognised” medical reasons have a higher chance of birth complications than other mums, a study has found.

A team from the University of Adelaide studied 28,000 births over a year, comparing spontaneous labours with inductions of women who were induced for medical reasons, and those who were induced for non-recognised medical reasons, such as living a long way from a hospital or wanting a birth to occur on a particular day or time.(canvas prints australia canvas photo prints)

    In the absence of serious maternal or fetal problems or a medical recommendation, induction is best avoided

The study found that inductions performed for non-recognised medical reasons ­led to a 67 per cent higher chance of having a caesarean section.

Babies who were induced for non-recognised medical reasons had a 64 percent higher risk of being admitted to the Neonatal Intensive Care Unit, and a 44 percent higher chance of needing medical treatment.

Rosalie Grivell, from the university’s Robinson Institute, said spontaneous labour had the best outcomes for mother and baby.

“In the absence of serious maternal or foetal problems or a medical recommendation, induction is best avoided,” she said.

Women had the lowest risk of having an epidural if they went into labour at or after 41 weeks’ gestation. Other results showed that mums were at the lowest risk of suffering a severe perineal tear if they laboured after 38 weeks’ gestation.

“We hope our findings will increase awareness of potential complications related to the common use of induction of labour in situations where there is no serious maternal or fetal problem,” Grivell said.

Women labouring longer than they did 50 years ago

A US study has found that women are spending longer in labour than they did 50 years ago.(canvas prints online canvas art prints)

Scientists at the National Institute of Child Health and Human Development compared 39,491 births from 1959 to 1966 with 98,359 births from 2002 to 2008. All the women had gone into labour without complications.

    The first stage of labour has increased by 2.6 hours for first-time mums, and by 2 hours for women who have already had children

The researchers found that the first stage of labour has increased by 2.6 hours for first-time mums, and by 2 hours for women who have already had children.

Babies of modern parents were born five days earlier, on average, than those in the 1960s, but also tended to weigh more.

So what caused the difference? The authors noted that on average, women in the modern group were 2.5 years older than those in the first. And women giving birth in the 2002-08 group had an average body mass index of 29.9, putting them close to the obese range, compared with 26.3 in the earlier group.

"Older mothers tend to take longer to give birth than do younger mothers," said the study's lead author, Dr S. Katherine Laughon. "But when we take maternal age into account, it doesn't completely explain the difference in labour times."

The researchers pointed to delivery room practices as a likely reason for the longer labours. Only 4 per cent of women in the earlier group received epidural analgesia, compared with 55 per cent in the recent group.

About 12 per cent of women in the '60s received oxytocin to induce labour, compared with 31 per cent in the modern group.

A team from the University of Sydney found that in Australia, epidural analgesia use increased from 17.2 per cent in 1992 to 26.5 per cent in 2003. In 1979, 75 per cent of births were to women under the age of 30; by 1999, births to women younger than 30 had dropped to 52 per cent. By 2009 this figure had dropped to 46 per cent, according to figures from the Australian Bureau of Statistics.

Labour the second time round - is it easier?

Pregnancy and labour go hand in hand with old wives tales. But while we may be able to dispel old ways to predict the sex of the baby, or labour inducing home therapies, is there any truth to labour being easier the second time round? A common perception is that a woman’s body will know what to do in a second labour and the whole experience will be easier than the first time.(canvas prints online acrylic prints)

Research has shown that compared to the first labour the duration of the second labour and even the oxytocin requirements in the second labour are significantly reduced. So does a shorter labour suggest it is an easier labour?

Approaching the birth of her first child, Kristy was concerned about labour and the birth process. Nineteen long hours later, with oxytocin and intervention she was cradling her beautiful daughter, with a sense of overwhelming exhaustion. Two years later she anticipated the birth of her second child very differently “I was more scared going into this labour than I was the first one because I knew what to expect in terms of pain, I knew how bad it was going to be.”

But it seemed the old wives tale was true for Kristy. Labour was only five hours and there was no oxytocin or intervention. “Your body does know what to do the second time round, it is like it has a memory, and I really listened to my body and did what my body wanted to do.” However, Kristy was quick to point out that a shorter, less complicated labour was not easier. “It is not easier in terms of the pain; the pain was more intense and I still had to get through it, both mentally and physically.”

Can women anticipate a second labour to be quicker and perhaps with less intervention? Midwife Liz Wilkes, from My Midwives and President of Midwives Australia, does agree that “second labours are generally shorter than first labours.” So it does seem that “for the majority of women this means that they typically experience it as a ‘better’ ‘easier’ experience, however it is not always the case.”

“For some women a very short labour means they have less time to adjust to what is happening.” Liz says that transition is usually much shorter “usually minutes, a few contractions” meaning the part of labour that was often very tough in the first birth is gone before the woman realises she is in it.  “Most women welcome this, but for a few, it may be an out of control experience.”

Jacqueline thought everything was going perfectly in her second pregnancy; she finished work five weeks before her due date, ready to settle in for some rest and nesting. Finishing work on the Wednesday, she fell ill with a stomach virus on the Thursday and went into her second labour on the Friday. “The first time I was more prepared, I was focused and could get through it, whereas this time I was caught by surprise and the whole thing felt like it was out of my control.”

Seventeen hours of labour the first time left Jacqueline apprehensive about what was about to happen; only to be surprised with a five hour second labour. But this mum does not think it was easier. “Labour was stronger and the pain was more intense because it was in a shorter period of time.” Jacqueline encourages that “quicker was better because it is not drawn out and it is reassuring knowing that your body does know what it is doing.”

Yet her words of advice to anyone facing a second or subsequent labour are perhaps more truthful than any wives tale could ever be. “Like every child is different, I think every labour is different and whether it is your first or second, you can only prepare so much and you should never expect it to be easy.”

While the perception may be that labour is easier the second time round, perhaps it is more so that mothers are more confident, more in-tune to the demands of and the capability of their body. Second time mothers may have also shed the inhibition and initial fears that cloaks labour the first time round. And while it seems labour can be quicker for subsequent births, quicker is not a scapegoat for easier.

Meconium stained liquor and meconium aspiration syndrome: the facts

What are meconium stained liquor and meconium aspiration syndrome?

Most infants have their first bowel movement, called meconium, in the first 24 hours after delivery. Mecomium is a sticky dark-green consistency, and when the amniotic fluid is tinted green or yellow, instead of being clear, it is called meconium stained liquor. This happens when an infant passes meconium before they are born.(canvas prints australia canvas printing sydney)

Meconium aspiration syndrome is when an infant inhales the meconium before, during or after labour. It can cause respiratory problems as serious as pneumonia, and although it rarely happens, it can be fatal.

Not all babies who are born with meconium staining will develop meconium aspiration syndrome, and those that do usually have their airways cleared quickly to prevent further health problems.

What are the risk factors?

Chances of meconium stained liquor and meconium aspiration syndrome are raised if any of the following are present:

- foetal distress during labour (such as having a difficult delivery or umbilical cord problems)
- being an older mother
- smoking cigarettes
- having medical conditions such as diabetes, high blood pressure or cardiovascular problems
- having an infection or placenta problems
- being overdue (meconium staining rarely occurs before 38 weeks of pregnancy).

What are the signs?

Besides stained amniotic fluid, other signs a baby may have meconium aspiration syndrome include breathing difficulties, a slow heartbeat, a distended chest or making “grunty” noises, and receiving a low APGAR score (which is based on a few different tests that evaluate a baby’s health straight after birth).

How are they diagnosed?

Meconium stained liquor is diagnosed through observation of the amniotic fluid.

Meconium aspiration syndrome can be diagnosed by listening to a baby’s lungs with a stethoscope for wet or crunchy sounds. If they can be heard, chest X-rays can be ordered to show patchy areas on the lungs. Blood can also be taken to show how much oxygen an infant has in their circulation, which can both be used to make a final diagnosis and start treatment.

What's the treatment?

Meconium stained liquor observed during labour is a signal for increased monitoring of the baby during labour.

Treatment depends on how much meconium is inhaled. If meconium staining can be seen during labour, an amniofusion can be performed to prevent aspiration syndrome. This is when the meconium is flushed out of the amniotic fluid with a saline solution before the baby can inhale it, although this practice isn’t usually performed in Australia.

If a baby has inhaled meconium but their heartbeat or breathing isn’t affected, they will be monitored but may not require any treatment.

Doctors can perform suction to remove the meconium from the trachea and lungs until it’s all gone. The baby may sometimes need antibiotics.

Some babies who have inhaled a lot of meconium will need to be placed on a ventilator and cared for in a neo-natal intensive unit. Many babies will be fine within a matter of days or weeks, although very rarely a baby may experience longer-term health issues such as asthma or developmental problems.

Practicing birth positions

There are many birthing positions that your partner can adopt to help facilitate an easier birth. You, my friend, will help her with these positions and will need to know them and to encourage her to try different positions as the labor progresses. (cheap canvas prints canvas print)

Some of these positions include squatting, kneeling and standing and all require good muscle strength to pull them off.  By practicing these positions during pregnancy you are not only doing a trial run for the big day you are also helping her strengthen the right muscles....don’t forget she’ll be a lot heavier then so the muscles will need time to adjust to her increasing weight over time.

    Don’t be a spectator in the Grand Prix of baby making. Be a co-driver, get behind the wheel and feel the exhilaration of building a baby and making a real difference.

All this sounds ridiculous and a waste of time right? Do you want your birth to be as enjoyable, painless (for mum, baby and YOU) and as memorable as possible? If the answer is Yes then start exercising today, or tomorrow if you are reading this in bed.

So there you have it lads. Assisting your partner to eat well and exercise are the two biggest ways that you can directly influence the health and development of your baby. Don’t be a spectator in the Grand Prix of baby making. Be a co-driver, get behind the wheel and feel the exhilaration of building a baby and making a real difference. It’s your first role as being a dad.

In defence of birth plans

"My personal view of birth plans is that they’re most useful when you set them on fire and use them to toast marshmallows. But there are some women who live for them: I call them Birthzillas because just like a Bridezilla focusses on the wedding not the marriage, The Birthzilla appears more interested in having a birth experience than a baby," writes Mia Freedman in the Sunday Telegraph in a piece on the decidedly ugly game of ‘My Birth Was Better Than Yours’.

Birthzillas, Bridezillas and perhaps all ‘Zillas’ are bad news. It’s amusing stuff, but the thing is, birth plans are helpful for many parents, and an increasing number of obstetricians and midwives request them. There are a number of reasons for this.(canvas prints canvas prints melbourne)

    Women have the right to control what is done to their bodies, always, including during the intense process of birth

The majority of Australian women choose to birth in hospital and all hospitals do not have the same protocols. It is easy to imagine they would, but they don’t, not from state to state and not even from hospital to hospital in the same city. Even individual health practitioners in the same facility sometimes do not follow the same protocols.

For instance, unless specifically requested, many hospitals do not automatically offer valuable skin-to-skin time, where baby is simply placed on mother’s chest straight after birth for about an hour, despite research showing substantial health benefits including increased success with breastfeeding and mother-baby bonding. (I recommend this very beautiful experience and thankfully most hospitals will offer it if requested, even in circumstances where mum has given birth by caesarean.)

Things like skin-to-skin are the sorts of thing you can put in your birth plan, along with other important requests, including who you would like present during birth, "I’d like my husband to be present to support me", "By no means let my in-laws into the birthing suite" etc. If you want those things but don’t express them, you may find bub whisked away for weighing and washing before you get the opportunity for skin-to-skin or your first breastfeed, and you might find your well-meaning mum-in-law wandering in when you aren’t ready for company.

Do you want pain medication offered, or would your rather ask for it yourself? Do you want to avoid certain optional medical procedures, like an episiotomy? Do you want cord blood saved for cord banking? The list goes on.

Women have the right to control what is done to their bodies, always, including during the intense process of birth when the body is arguably most out of our individual control. Informed consent is important in birth, as it is in our sexual experiences, in breastfeeding, and in the sadder times when illness and death take over. During these times it pays to be particularly clear about our wishes and requests, to ourselves, but most importantly to those who will be in that experience with us – our carers, our partners, our doctors, our families, our friends.

Clearly communicated requests about what we would or would not like to have done to our bodies is important, which is why birth plans are recommended by many obstetricians and midwives. These requests are not set in stone, of course, but it pays to write our requests down and chat clearly with our chosen health practitioner about those requests beforehand because: a) we then don’t have to worry about what unknown things will be done to us in various circumstances, as the different scenarios will have been discussed clearly beforehand, b) our carers will know what our wishes are and can communicate them to all of the staff who will be involved in our care, and c) we are actively involved in the decisions made about your bodies and the bodies of our newborn children.